• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Berinert is and what it is used for
2. What you need to know before you use Berinert
3. How to use Berinert
4. Possible side effects
5. How to store Berinert
6. Contents of the pack and other information

Berinert is presented as powder and solvent. The made-up solution of Berinert 500 IU is to be given by injection or infusion into a vein. Berinert 1500 IU may be given by slow injection only.

Berinert is made from human plasma (this is the liquid part of the blood). It contains the protein human C1-esterase inhibitor as active ingredient.

Berinert is used for the treatment and pre-procedure prevention of the hereditary angioedema type I and II (HAE, oedema = swelling).

HAE is a congenital disease of the vascular system. It is a non-allergic disease. HAE is caused by deficiency, absence or defective synthesis of C1-esterase inhibitor, an important protein.

The illness is characterised by the following symptoms:

• swelling of the hands and feet that occurs suddenly,
• facial swelling with tension sensation that occurs suddenly,
• eyelid swelling, lip swelling, possibly laryngeal (voice box) swelling with difficulty in breathing,
• tongue swelling,
• colic pain in abdominal region.

Generally, all parts of the body can be affected.

• if you are allergic to the protein C1-esterase inhibitor or any of the other ingredients of this medicine listed in section 6.

Please inform your doctor or pharmacist if you are allergic to any medicine or food.

• if you have experienced allergic reactions to Berinert in the past. You should take antihistamines and corticosteroids prophylactically if advised by your doctor.
• when allergic or anaphylactic-type reactions occur (a serious allergic reaction that causes severe difficulty in breathing or dizziness). The administration of Berinert should then be stopped immediately (e.g. discontinue injection)
• if you suffer from laryngeal swelling (laryngeal oedema). You should be carefully monitored with emergency treatment in stand-by.
• during unlicensed use beyond the approved indications and posology (e.g. Capillary Leak Syndrome, CLS). See section 4. “Possible side effects”.

Your doctor will consider carefully the benefit of treatment with Berinert compared with the risk of these complications.

When medicines are made from human blood or plasma, certain measures are put in place to prevent infections being passed on to patients. These include:

• careful selection of blood and plasma donors to make sure those at risk of carrying infections are excluded, and
• the testing of each donation and pools of plasma for signs of virus/infections.

Manufacturers of these products also include steps in the processing of the blood or plasma that can inactivate or remove viruses. Despite these measures, when medicines prepared from human blood or plasma are administered, the possibility of passing on infection cannot be totally excluded. This also applies to any unknown or emerging viruses or other types of infections.

The measures taken are considered effective for enveloped viruses such as human immunodeficiency virus (HIV, the AIDS virus), hepatitis B virus, hepatitis C virus (inflammation of the liver) and for the non-enveloped viruses hepatitis A (inflammation of the liver) and parvovirus B19.

Your doctor may recommend that you consider vaccination against hepatitis A and B if you regularly/repeatedly receive human plasma-derived products.

It is strongly recommended that every time that Berinert is given, the date of administration, the batch number and the injected volume should be recorded.

• Please tell your doctor or pharmacist if you are taking or have recently taken any medicines, including medicines obtained without a prescription.
• Berinert should not be mixed with other medicinal products and diluents in the syringe/infusion set.

• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
• During pregnancy and breast-feeding Berinert should be given only if it is clearly needed.

No studies on the effects on the ability to drive and use machines have been performed.

Berinert 500 IU contains up to 49 mg sodium (main component of cooking/table salt) in each vial. This is equivalent to 2.5 % of the recommended maximum daily dietary intake of sodium for an adult.

Berinert 1500 IU contains less than 1 mmol sodium (23 mg) per vial, that is to say essentially ‘sodium-free’. .

Adults

Treatment of acute angioedema attacks:

20 IU per kilogram body weight (20 IU/kg b.w.).

Pre-procedure prevention of angioedema attacks:

1000 IU less than 6 hours prior to a medical, dental, or surgical procedure.

Treatment of acute angioedema attacks:

20 IU per kilogram body weight (20 IU/kg b.w.).

Pre-procedure prevention of angioedema attacks:

15 to 30 IU per kilogram body weight (15-30 IU/kg b.w.) less than 6 hours prior to a medical, dental, or surgical procedure. Dose should be selected taking into account clinical circumstances (e.g. type of procedure and disease severity).

No case of overdose has been reported.

Berinert is usually injected into a vein (intravenously) by your doctor or nurse. You or your carer might also administer Berinert as an injection, but only after receiving adequate training. If your doctor decides that you may be suitable for such home-treatment, he/she will give you detailed instructions. You will be required to keep a diary in order to document each treatment received at home and to bring it to each of your visits to the doctor. Regular review of your/your carer’s injection technique will be performed to ensure continued appropriate handling.

• The powder must be dissolved and withdrawn from the vial under aseptic conditions. Use the syringe provided with the product.
• The made-up Berinert 500 IU solution should be colourless and clear. Berinert 1500 IU may be colourless and clear to slightly opalescent. After filtering or withdrawal (see below) the solution should be checked by eye for small particles and discoloration, before it is administered.
• Do not use the solution if it is visibly cloudy or if it contains flakes or particles.
• Any unused product or waste material should be disposed of in accordance with local requirements and as instructed by your doctor.

Without opening either vial, warm the Berinert powder and the solvent to room temperature. This can be done either by leaving the vials at room temperature for about an hour, or by holding them in your hands for a few minutes. DO NOT expose the vials to direct heat. The vials must not be heated above body temperature (37°C).

Carefully remove the protective caps from the solvent vial and the product vial. Clean the exposed rubber stoppers of both vials with one alcohol swab each and allow them to dry. The solvent can now be transferred to the powder with the administration set (Mix2Vial) attached.

Please follow the instructions given below.

1. Open the Mix2Vial package by peeling off the lid. Do not remove the Mix2Vial from the blister package!

2. Place the solvent vial on an even, clean surface and hold the vial tight. Take the Mix2Vial together with the blister package and push the spike of the blue adapter end straight down through the solvent vial stopper.

3. Carefully remove the blister package from the Mix2Vial set by holding at the rim, and pulling vertically upwards. Make sure that you only pull away the blister package and not the Mix2Vial set.

4. Place the product vial on an even and firm surface. Invert the solvent vial with the Mix2Vial set attached and push the spike of the transparent adapter end straight down through the product vial stopper. The solvent will automatically flow into the product vial.

5. With one hand grasp the product-side of the Mix2Vial set and with the other hand, grasp the solvent-side and unscrew the set carefully into two pieces.

Discard the solvent vial with the blue Mix2Vial adapter attached.

6. Gently swirl the product vial with the transparent adapter attached until the substance is fully dissolved. Do not shake.

7. Draw air into an empty, sterile syringe. Use the syringe provided with the product. While the product vial is upright, connect the syringe to the Mix2Vial's Luer Lock fitting. Inject air into the product vial.

8. While keeping the syringe plunger pressed, invert the system upside down and draw the solution into the syringe by pulling the plunger back slowly.

9. Now that the solution has been transferred into the syringe, firmly hold on to the barrel of the syringe (keeping the syringe plunger facing down) and disconnect the transparent Mix2Vial adapter from the syringe.

Berinert 500 IU solution is to be administered by slow intravenous injection or infusion (4 ml/minute). Berinert 1500 IU solution is to be administered by slow intravenous injection only.

• if any of the side effects occur, or
• if you notice any side effects not listed in this leaflet.

Undesired reactions with Berinert are rare.

The following side effects have been observed rarely (may affect up to 1 in 1000 people):

• There is a risk of increased formation of blood clots in treatment attempts for prophylaxis or therapy of Capillary Leak Syndrome (outflow of fluid from the small blood vessels into the tissue) e. g. during or after cardiac surgery under extra-corporal circulation. See section 2 "Warnings and precautions".
• Increase in body temperature as well as burning and stinging where the injection was given.
• Hypersensitive or allergic reactions (such as irregular heartbeat, faster heartbeat, fall in blood pressure, reddening of the skin, rash, difficulty in breathing, headache, dizziness, sickness).

In very rare cases (may affect up to 1 in 10,000 people), hypersensitive reactions might progress as far as shock.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects, you can help provide more information on the safety of this medicine.

United Kingdom:

or search for MHRA Yellow Card in the Google Play or Apple App Store

Malta:

The active substance is:

Human C1-esterase inhibitor (500/1500 IU/vial; after reconstitution with 10/3 ml water for injections 50/500 IU/ml)

See section “The following information is intended for healthcare professionals only” for further information.

The other ingredients are:

Glycine, sodium chloride, sodium citrate

See last paragraph of section 2. "Important information about some of the ingredients of Berinert".

Solvent: Water for injections

Berinert is presented as a white powder and is supplied with water for injections as solvent.

The made-up Berinert 500 IU solution should be colourless and clear. Berinert 1500 IU may be colourless and clear to slightly opalescent.

Box with 500/1500 IU contains:

1 vial with powder (500/1500 IU)

1 vial with 10 ml / 3 ml water for injections

1 filter transfer device 20/20

Administration set (inner box):

1 disposable 10 ml / 5 ml syringe

1 venipuncture set

2 alcohol swabs

1 plaster

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: